I hate the TDI only matters, if that was true there would be no flu action of basal. No correction, no I/c card ratio. But I am not going to get into any of that today. I have post where I explained my prospective, I cam to reascherch in, verses listing to a pod cast.
The glucose goal range is only for your chart tracking though, it’s not a functional input…. Only the correct above is for the algorithm (and I’m not sure if that just inputs to the bolus calculator or actually affects the algorithm….) but I’m pretty confident the goal range doesn’t influence the auto algorithm at all
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Thanks @bkh. I think the goal range is actually working like you suggest in OP5, but I am no expert, for sure.
The goal range is not a functional input with this particular system
I sure wish it allowed a little more aggressive auto basal adjustments toward the target glucose, perhaps in future versions that’ll be a thing
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thank you and understood, it is just a theory of mine, and hope I have never presented as anything else. I don’t even discuss on other pages because I don’t to miss led. I am just “let me say” attempting to explain to myself the reaction of the basal it gives to the bg readings it gets from the Dexcon. I am more mechanical, and I see a relationship between the two that is not consistent with common explanations.
when I changed my settings to TTIR (80-140) it acted different than with the 70-180 range with my basal, for example before it would start reducing basal at 180, now it does not start reducing until around 140.
I have to go here, I hate the only thing it uses is TDI to determine basal, will true, the devil lies in how it uses that number. anyway I am not going into that, I’ll just say I have a post on here explaining my thoughts on this
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This is page 142 of the users manual. It’s not from a podcast.
Note: The Glucose Goal Range does not impact insulin delivery.
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I am new to the OP5 and have been missing my dual bolus feature which my old Medtronic pump had. How do I go about this using the POD? (Like when I want to eat pizza or other high fat foods (Like Grilled Cheese Sandwiches)
Could someone explain this for me?
DM
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Welcome to O5, @daisymae . I’m not familiar with Medtronic’s dual bolus, but with the pod you can do an extended bolus. You have to have Extended Bolus turned on (in Settings / Bolus), and you have to be in Manual mode. Then the Extended Bolus option appears at the bottom of the usual bolus screen. You can then select the dose you want now and how long you want the remainder delivered over (this sounds like dual bolus). This is with the PDM; I assume the app is similar.
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Hi there Beacher. Hope youre well. Thanks for your input on the Extended Bolus. Does that just deliver insulin over a period of time, of your choosing? A dual bolus is when you can program your pump (Medtronic, anyways) to deliver a % up front, and then the balance % over a certain period of time. Like, if I wanted to eat pizza, I might “tell” the pump to give me coverage for 30gms up front, and then 30gms (50% and 50%) over a extended two hour period of time. But you can split it anyway you choose (or need). 60%/40%. 40%/60%, etc. Over 1 hour, two hours, three hours, etc. This helps particularly with high fat foods that slow down digestion. Whenever I would have a Grilled Cheese with double cheese on Rye with grilled tomato, I would bolus 40% upfront, and then 60% over a two hour period. It kept me from spiking and I rarely went over 200 BG for the six hour insulin duration time (4 hours, plus the 2 hour extended bolus).
DM
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Yup, sounds like Medtronic and Omnipod work the same way. With the O5 you can choose any percentage to deliver up front, from 0% to 100% (in which case it isn’t an extended bolus, obviously), and delivery time in half-hour increments from 0.5 hr to 8 hrs.
Set a timer so you remember to switch back to Automated mode once the extended bolus is finished. And add a couple of minutes to the timer, or check in History Detail that the extended bolus is confirmed to have finished, before you make the switch. If you’re too quick, as I was a couple of times, and the main screen shows it’s finished but your History shows you still have 0.05 units to go, you risk getting a communication error and the screaming pod.
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“Extended boluses” are one of the items that have caused a lot of heated argument with the developers of AIDSes like AAPS and, I assume, Loop.
An extended bolus, in the original meaning (a meal bolus delayed over time) is not possible with an AIDS because the AIDS will cancel it out, or rather amend it; it might increase it if there was an underestimate.
Likewise a “basal” gets semi-cancelled; if a bolus or a basal is too low the AIDS will increase the basal (some systems) or do a “micro bolus” (becoming more common these days). If a basal is too high the AIDS will simply reduce it.
None of this is O5 specific; it’s just the way stuff works out as a result of having an AI handle our glucose.
Some, a lot maybe, of what is said in this thread is a consequence of the world we have lived in; we had to deal with approaches like carb counting, multiple “ratios”, basal etc and for those of us who survived it took a lot of work. Or, in my case, no work and a lot of ignorance; very healthy ignorance of course.
When we want an “extended bolus” we are actually wanting “extended carbs”; that’s why the bolus needs to be extended.
One way round this that I use sometimes with AAPS is to just enter the carbs; no bolus. Then the AIDS has some meaningful data to work with and can adapt to the slowly metabolised carbohydrates/proteins/fat.
Another that I pretty much never use is a temporary basal. Insulin is insulin; the molecules aren’t labelled “basal” or “bolus” and even if they were our metabolism would not understand. So a “temporary basal” biases the AIDS towards delivering more insulin and at the same time it retains its ability to deal with under/overestimates = high/low BG.
Like I implied before, that’s very scientific and I would wholely support my own arguments but what I do is what I might have implied. I just do a bolus if I go high and let the AIDS deal with the consequences.
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Now I am totally confused. I dont know what AAPS, AIDS are. Nor do I understand what a temporary bolus or basal rate have to do with extended boluses. All I want to know is how to use an Extended Bolus and how many hours I should put in the POD for. If I usually take 65gms u/h divided by a 40/60% TB over 2 hours, do I do an extended bolus for 2 hours? Or do I do it for 4 hours? (or anything else).
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AIDS: Automated Insulin Delivery System. A pump (an “acePump”) a CGM (an “iCGM”) and a controller (possibly an “iController”, there seems to have been some contention about the precise names). The iCGM sends readings to the iController which takes input from the user (us) like carbs and so on then it tells the acePump how much insulin to deliver. Recent Tandem, twiist, Omnipod 5 are all such systems but not all have FDA approval as an acePump; that’s an extra step. G7, LIbre 3+ and EverSense are iCGMs (i.e. they have the required FDA approval) IRC (If i Remember Correctly).
AAPS: the new approved name for “Android APS”. An iController (without FDA approval.) A self built version (derivative, “fork”) of Loop which itself is the basis of most, maybe all, of the iControllers. So far as I know only twiist offers an FDA approved direct derivative of Loop.
Yeah, sometimes I get it wrong and say “temporary bolus” when I mean “temporary basal” but it doesn’t matter because a “temporary basal” gives a (modified) “basal rate” and it is an “extended bolus”. They are both exactly the same thing. I’d have to invent a fourth term to explain it properly but the “basal” is the delivery of insulin that happens regardless, a “temporary basal” is a delivery that only happens for a limited/specified amount of time and an “extended bolus” is exactly the same thing.
So, to make it clear. An “extended bolus” is just a “temporary basal”.
I’m lost as to what the units are but if the duration of the “extended meal” is 2 hours then the “temporary basal” is 2 hours as well.
The calculation is to work out how many units of insulin [IU] you are trying to delay for the carbs (et al.) then divide by the number of hours of the delay you want, to get IU/hour and add that to your current basal to get a temporary basal.
The IU can be obtained most safely from the calculator but I’m not sure if the modern AIDS systems give a straight number; the IU required to cover the carbs but without any corrections for …a whole load of other confusing terms… None of these terms are standardised but, in my system:
IU = carbohydrate-in-grammes / IC
“IC” is described as the “Insulin to Carb ratio” in my system but it is self-evidently the “Carb to Insulin ratio”. So mine is expressed as “10” which means 10g/IU and I just divide the carbs I want to delay by 10 to get some amount of insulin, in IU, to add to the basal.
I don’t do this any more because I use an AIDS so I don’t pull out a calculator to control my diabetes any longer (hum, I didn’t before either; I just got it wrong!)
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Thank you so much for the clarification. I still dont understand most of it, but I figure I’ll give it a try anyway and see what happens. God knows, when theres a favored food involved, I’ll figure it out!!!
Omnipod’s “extended bolus” works the same way as Medtronic’s “dual wave bolus.” Same thing, different names.
On the Omnipod, punch in the same numbers you did with your Medtronic. From your example, 40% now, duration 2 hours. There’s no reason to change it to 4 hours just because it’s a different pump.
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Thank You Beacher. Now I just have to find the right screen to set up the bolus. Can you guide me there?
Thanks, DM
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@daisymae Here are a few screenshots to get there: (those are my numbers for BG and carbs for the example).
- Switch to Manual mode (Extended bolus is not available in Auto mode)
- Push the Bolus button, then enter your carbs and BG. Push “extend bolus” button”
- Enter the % you want now for the bolus (my example is 75%) and the duration you want for the remaining part of the bolus (my example is 0.5 hour), hit “confirm” and it starts the bolus.
Hope that helps!
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First, in Settings > Bolus, make sure Extended Bolus is toggled on.
Then switch to Manual Mode.
From the home screen, enter the bolus screen the same way you always do. It’ll show the “Extended Bolus” option at the bottom. (This doesn’t show when you’re in Automated mode.) After you enter carbs and BG, tap “Extended Bolus,” and then fill in your desired % now and duration. And away you go!
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Exactly. I was trying to explain how to make it happen in automated mode. My understanding is that @daisymae is using automated mode. Switching back to “manual” mode pretty much just means you are using a Dash pod, possibly with low-bg suspend.
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John, you have no idea how helpful your instructions were. Now I can use it for Pizza on my Birthday this coming Saturday!!!
DM
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